活髓切断联合断冠再粘接术治疗上颌年轻恒前牙复杂冠根折的临床疗效及预后因素分析
Clinical efficacy and prognostic factors of pulpotomy combined with fragment reattachment in treating complicated crown-root fractures of maxillary young permanent anterior teeth
作者：杨鑫, 王园源, 陈婵婵, 丁桂聪, 廖心敏, 廖志清
Author：Yang Xin, Wang Yuanyuan, Chen Chanchan, Ding Guicong, Liao Xinmin, Liao Zhiqing
收稿日期：2025-04-07 年卷（期）页码：2026,44(2):188-188-196
期刊名称：华西口腔医学杂志
Journal Name：West China Journal of Stomatology
关键字：复杂冠根折,断冠再粘接,活髓切断,年轻恒牙,生存分析,
Key words：complicated crown-root fracture,fragment reattachment,pulpotomy,young permanent teeth,survival analysis,
基金项目：
中文摘要
目的 探讨活髓切断联合断冠再粘接术治疗年轻恒前牙复杂冠根折的临床疗效。 方法 回顾性分析2019年1月—2023年12月深圳市儿童医院收治的37例复杂冠根折患儿的临床资料，评估断冠存留率、牙髓存活率、牙根发育及牙周健康状况，并分析相关影响因素。 结果 术后1、2年断冠存留率分别为80.9%和69.5%，剩余牙冠高度是影响存留率的关键因素（P<0.05，风险比=7.45，95%置信区间：1.28-43.48）。牙髓1年存活率为91.6%，未发现显著影响因素。断冠存留满1年的病例中，Nolla 8期患牙的牙根增长百分比及根尖孔缩窄百分比均显著高于Nolla 9期（P<0.05）；59.3%牙周评分正常。 结论 活髓切断联合断冠再粘接术可有效保存牙髓活力并恢复牙齿功能形态，剩余牙冠高度是断冠存留的核心预测指标。该术式对年轻恒牙的牙根发育具有促进作用，临床预后良好。
英文摘要
ObjectiveThis study aimed to evaluate the clinical efficacy of pulpotomy combined with fragment reattachment in treating complicated crown-root fractures of maxillary young permanent anterior teeth.MethodsA retrospective analysis of 37 cases of complicated crown-root fractures treated at Shenzhen Children’s Hospital from January 2019 to December 2023 was conducted. Outcomes such as fragment retention rate, pulp survival rate, root development, and periodontal health were assessed, and the influencing factors were analyzed.ResultsThe fragment retention rates were 80.9% at 1 year and 69.5% at 2 years. The remaining crown height (cervical half group vs. incisal half group) emerged as a critical predictor of retention (P<0 .05, hazard ratio="7.45," 95% confidence interval: 1.28-43.48). the pulp survival rate reached 91.6% at 1 year, with no significant influencing factors identified. in cases where the fractured crown retained for over one year, teeth at nolla stage 8 showed significantly greater root elongation and apical foramen narrowing compared to those at nolla stage 9 (P<0 .05), normal periodontal scores were observed in 59.3%.ConclusionPulpotomy combined with fragment reattachment effectively preserves pulp vitality and restores dental function and morphology in young permanent anterior teeth. The remaining crown height serves as a key prognostic indicator for fragment retention. This approach also promotes root development and demonstrates favorable clinical outcomes.
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